Gynaecological oncology Flashcards
What is the name of the pre-malignant condition of the cervix?
CIN
What proportion of women will develop cervical cancer over the next 10 years if they leave CIN II/III untreated?
1/3rd
What are the RFs for CIN and cervical cancer?
- HPV exposure
- Oral contraceptives
- Smoking
- Immunocompromise
Which strains are most commonly associated with HPV?
16, 18, 31, 33
Which replication protein does HPV encode?
E1
Which HPV strains does Gardasil protect against?
6, 11, 16, 18
Which strains of HPV are responsible for what proportion of cases of genital warts?
6 and 11 - responsible for 90%
What proportion of cases of cervical cancer do HPV strains 16 and 18 account for?
75% (and 75-80% of anal cancer)
How is CIN Dx?
Cervical smear = a histological Dx since women with CIN is asymptomatic
What is CIN I?
Atypical cells in the lower third of the epithelium only
What is CIN II?
Atypical cells in the lower two thirds of the epithelium only
What is CIN III?
Atypical cells found full thickness. Similar in appearance to malignant lesions, but do not invade the basement membrane
Between what ages are women invited for 3-yearly cervical smears?
25-49
Between what ages are women invited for 5-yearly cervical smear?
50-64
Since the introduction of screening, by what % has cervical cancer cases dropped per year?
7%
What proportion of cervical smear samples are inadequate?
2.3%
Why might a cervical smear sample be inadequate?
Sample vaginal rather than cervical; composed of endocervical cells; contains insufficient cells
What proportion of adequate samples are abnormal?
6.5%
How might a cervical sample be abnormal?
Borderline changes - 3.5% CIN I - 1.8% CIN II - 0.5% CIN III - 0.6% Suspected invasive cancer or glandular neoplasia - 0.1%
How is a woman with a borderline of CIN I result, who is HPV -ve, followed up?
Back to routine recall
How is a woman with a borderline of CIN I result, who is HPV +ve, followed up?
Colposcopy (within 8wks), followed by screening at 6, 12 and 24 months
How is a woman with CIN II or III followed up?
Colposcopy (within 4wks) + LLETZ, followed by screening at 6 and 12 months, and then annually for 9 years (i.e. 10 year F/U)
How is neoplasia followed up?
Urgent colposcopy (within 2wks)
How may cervical cancer present?
- Asymptomatic
- PCB
- IMB
- PMB
- Offensive PV discharge
What are the two type of cervical cancer?
- Squamous carcinoma
2. Adenocarcinoma
When does endometrial cancer tend to occur?
Highest prevalence at 60y/o, <15% occurring pre-menopausally
What are the two most common types of endometrial cancer?
- Adenocarcinoma (>90%)
2. Adenosquamous carcinoma
What are the RFs for endometrial cancer?
- Unopposed oestrogen excess - exogenous oestrogens, e.g. tamoxifen, and endogenous oestrogens, e.g. in obesity, PCOS, nullparity and late menopause
- DM
- HTN
- Lynch syndrome
What is the most common presentation of endometrial cancer?
PMB
What tends to be cause of death in ovarian cancer?
Bowel obstruction and/or perforation
What are the protective factors for ovarian cancer?
- COCP
- Tubal ligation
- Pregnancy
- Breast feeding
What are the risk factors for ovarian cancer?
- Nullparity
- Non-breast feeding
- Infertility
- Total menstrual years
- FHx
- Unopposed exogenous oestrogen
What are the 3 types of ovarian tumours?
- Epithelial tumours - accounts for 90% of ovarian malignancies
- Germ cell tumours
- Sex cord tumours
How may ovarian cancers present?
- Asymptomatic
- Bloating
- Early satiety
- Anorexia
- Pain (uncommon)
- Urinary uregency/frequency
What blood marker should be measured in suspected ovarian cancer?
CA-125
What factors does the risk of malignancy index (RMI) take into account?
- U = USS
- M = menopausal status
- CA125
A patient complaining of a lump in their ‘privates’ may be suffering from what?
- Syphilitic chancre
- Vulval warts
- Bartholin’s gland cyst
- Bartholin’s abscess
- Congenital vaginal cyst
- Carcinoma of the vulva
- Carcinoma of the vagina
